May is skin cancer awarenness month
Melanoma survivor Alan Paul, of Southwick, sits in the Infusion Suite of the D'Amour Center for Cancer Care at Baystate Medical Center with hospital oncologist Dr. John McCann. May is National Melanoma/Skin Cancer Detection and Prevention Month, designed to raise awareness and to encourage early detection. Also, the Friday before Memorial Day is "Don't Fry Day" to further raise awareness and steps toward prevention.
Melanoma survivor Alan Paul, of Southwick, knows all about this potentially deadly form of skin cancer, and about the fact that it is not confined to sun worshippers.
"I was in the sun for a while when I was a kid, like anyone else, but I was never a sun worshipper, that's the strange part," said Paul, 42, who noted his daughter discovered a mole in the exact same spot as his, but it was non-cancerous.
According to the American Cancer Society, skin cancer - the most common of all cancers - accounts for nearly half of all cancers in the United States. More than 3.5 million cases of basal and squamous cell skin cancer are diagnosed each year. Some 76,600 cases of melanoma, the most serious type of skin cancer, will be diagnosed this year.
Melanoma accounts for more than 9,000 of the more than 12,000 skin cancer deaths each year. Studies have confirmed that exposure to the sun's ultraviolet rays is responsible for the development of at least two-thirds of all deadly melanomas.
"Many skin cancers can be prevented by simply refrain-ing from being a sun worshipper and staying away from tanning beds," said Dr. Richard Arenas, chief of surgical oncology, Baystate Regional Cancer Program.
"Early detection is one of the best ways to cure melanoma," Arenas added in a submitted hospital story.
Paul's wife was the one who first noticed the mole on her husband's upper back, which she thought "didn't look too good."
"I waited too long after she told me about it, then it got irritated and started to bother me," said Paul, whose dermatologist had the lesion biopsied and sent him to see Arenas.
"I had no idea how bad it was until I learned from Dr. Arenas that it was a stage 3 cancer. It was scary. When I asked him what it meant for me, Dr. Arenas assured me I was going to be around for a long time and that if he couldn't help me, I wouldn't be there talking to him."
The challenge presented by melanoma is that unlike other skin cancers, it has a greater opportunity of spreading to any area of the body such as the lungs or brain, but usually spreads first to the lymph nodes.
"The deeper the lesion, the deeper it invades through the skin and the greater the chances of the cancer traveling to the lymphatic system and into the nodes.
Unfortunately, when it metastasizes through the lymph nodes to other parts of the body, the likelihood of a cure drops significantly," Arenas said.
"If the melanoma is thin, about 1 millimeter or less in thickness, the chances of the cancer spreading through the lymph nodes is below five percent. That is why early detection is so critical before the melanoma becomes thicker and more invasive," he added.
The other problem with melanoma is that for those whose cancer has spread to the lymph nodes, there is a greater chance of recurrence - even more so than breast or colon cancer, for example - either near the previous site or in a completely different area.
Paul was one of the lucky ones. After two operations, one to remove the cancerous lesion on his back, then to remove lymph nodes from under his arms, he is now cancer free and there is no indication of his cancer spreading to other parts of the body.
However, for right now, the Southwick man must undergo a PET scan and MRI every three months to check for any recurrences of his cancer.
"Because the recurrence rate is higher, there is currently an effort in the medical community to try to find more effective treatments for those diagnosed with melanoma that has spread to the lymph nodes," Arenas said.
While the main treatment for melanoma is surgical removal of the lesion - which can often cure early-stage cancers before they metastasize - depending on the stage of the tumor and its spread, doctors will often recommend additional treatment with the drug interferon-alfa2b (IFN).
"While new and different chemotherapy drugs have completely changed the survival of some cancers for the better, when it comes to melanoma, our primary reliance has been on IFN," Arenas said.
Oncologist Dr. John McCann from the Baystate Regional Cancer Program is optimistic about the potential of newer treatments.
"Today we have newer treatments that are beginning to show hope in improving the survival rate for those with advanced metastatic melanoma. We can look for specific genetic abnormalities and there are now pills available that can benefit those patients with certain mutations in the melanoma cell. We also have medicines that can activate the immune system to attack the melanoma cells," McCann said.
Also, McCann is serving as the principal investigator in a national trial now underway at Baystate Medical Center to look at a medication that can stimulate the immune system.
"We are testing this medicine in the preventive setting for those who have had a melanoma removed, to see if it will prevent the recurrence of their cancer," said McCann said.
Because IFN is very difficult for many patients to tolerate due to of its high toxicity and resulting side effects, Paul opted to enroll in the trial.
"I was reluctant at first because of the unknown. But I decided to give it a try, not just for my own sake, but to help others who may benefit from this new drug in the future," said Paul about the study.
Heather Riggenbach, of Westfield, who had her first surgery in March 2012 to excise a melanoma on her abdomen followed by the extensive removal of lymph nodes under her right armpit, was ineligible for the trial and opted for IFN treatment.
"I got all the possible side effects you could have while taking interferon - it made me too sick - so I ended the treatment after just six weeks," said Riggenbach about the preventive medication to lower her chances of recurrence.
"I thought I was in remission, but then felt a lump about two months ago above where my original melanoma was located. It was melanoma again," she added.
Since Riggenbach is unable to tolerate interferon treatment to help prevent a recurrence, she is being closely watched by Arenas with appointments every three months to check for any spread of her cancer.
An otherwise healthy young woman who was just finishing graduate school as an occupational therapist when she had her first surgery, Riggenbach, 25, is an example of how early melanoma can strike.
"I did use tanning booths when I was in high school, but when I was out in the sun, I used 30 SPF sun block lotion as you hear so many doctors recommend," she said.
Riggenbach - who now works as an occupational therapist at Baystate Rehab Care - credits her supervisor there while finishing her clinical field work for college back in 2011 for noticing the mole on her stomach and telling her to get it checked.
Riggenbach used her own career training as a therapist to promote her recovery, Arenas noted, after she began to develop axillary webbing syndrome (AWS), also referred to as cording.
The painful syndrome - for which she turned for help from other therapists at Baystate Rehab Care, whom she grew to know during her clinical study there as a college student - involves the thickening of ropelike structures located under the skin of the inner arm, which makes it difficult to lift your arm.
"In her role as an occupational therapist at Baystate Medical Center, Heather is now interested in helping other melanoma and cancer patients who are expected to face the same challenges in their recovery," Arenas said.
Riggenbach is currently doing additional research on AWS for information that will be placed on the Baystate Health website.
According to Arenas, people should examine their skin from head to toe every month and see their physician every year for a skin exam. Melanoma is most often found in men between the shoulders and hips, and on the head and neck.
Women often develop melanoma on the lower legs. Look for changes in moles - those that are larger than normal, variable in color, and have irregular borders - as well as warts and other blemishes on the skin, especially those parts exposed to the sun.
The U.S. Food and Drug Administration offers the following tips for sun safety:
- Use Broad Spectrum sunscreens with SPF values of 15 or higher regularly and as directed.
- Reapply sunscreen at least every 2 hours, more often if you're sweating or jumping in and out of the water.
- Limit time in the sun, especially between the hours of 10 a.m. and 2 p.m., when the sun's rays are most intense.
- Wear clothing to cover skin exposed to the sun; for example, long-sleeved shirts, pants, sunglasses and broad-brimmed hats.
- It is also advised to keep newborns out of the sun and use sunscreen only on those over the age of 6 months.
For related information, visit www.skincancerprevention.org/